Dr. Paul S. Stanford

Closely related to family therapy, couples therapy is a type of counseling that seeks to help couples improve their relationship. A therapist may teach each partner in the relationship specific skills, such as managing or expressing their emotions, conflict resolution, communication skills, and problem solving. Both people in the couple need to be committed to learning new skills themselves as well as putting effort into supporting the relationship. The typical goals of couples therapy are to decrease conflict, unhappiness, and resentment, as well as increase communication, intimacy, and connection.

Couples therapy may be offered privately, at a university, or in a group practice. It is usually short-term therapy, lasting a few weeks until the participants have learned new skills and have the ability to repair their relationship. Its effectiveness depends on the willingness of both participants to commit to therapy and make the relationship a priority. For many couples it can be extremely helpful.

Each family member can be affected by an issue in an individual and unique way, typically depending on age, maturity, and involvement. This means that family issues are often inequitable, with one or more family members bearing a disproportionate weight of the problem. A frequent example is parental divorce. While both parents may appreciate the immediate relief, divorce can rapidly threaten a developing child's sense of stability and self-confidence. Similarly, a mother who is subject to domestic abuse may conceal the issue in order to shield her children from her distress. In some cases, family issues are generational; a father may cause residual guilt or disagreements from his childhood to carry forward to his own son. While each family's experience is unique, common family issues can include:

• Financial disputes
• Divorce and separation
• Abuse and violence
• Narcissistic caretaker(s)
• Death
• Infidelity and relationship issues
• Sibling rivalry
• Religious and cultural conflicts
• Lifestyle disagreements
• Severe physical illness
• Mental health issues
• Neglect
• Retirement and older adulthood
• Unsafe or unstable household environment

Some family issues are inevitable – such as retirement and minor lifestyle disagreements – while others can be unexpected and dramatic. Unsafe household environments, abuse, and neglect can lead to severe trauma and intervention by social services or law enforcement.

Most common family issues can be addressed through therapy with one or more family members. Family therapy involves sessions led by a licensed mental health therapist. These sessions often include family discussion, resolution strategies, and other activities to promote family harmony. Another form of treatment for family issues is couples counseling, in which a couples counselor can help spouses communicate and employ problem-solving techniques to improve the strength of their relationship. For children, specialized child therapy can help children and adolescents manage and overcome family issues with age-appropriate methods.

Some people find individual therapy or counseling beneficial in resolving family issues, especially for those who are unable to attend family therapy with other family members. Therapists may encourage the creation of family boundaries. At an extreme, therapy may cause an adult to come to the conclusion that communication with a narcissistic parent must stop in order to preserve mental health and wellbeing.

• Frequent intense sexual fantasies, urges, and behaviors that feel involuntary or beyond an individual's control
• Numerous unsuccessful attempts to stop or reduce sexual behaviors
• The use of sexual behaviors as an attempt to deal with other problems, such as loneliness or depression
• Feeling guilt or remorse after engaging in repeated sexual behaviors
• The inability to stop engaging in sexual behaviors despite negative consequences such as contracting a sexually transmitted infection, damaging important relationships, losing a job, or developing financial or legal problems
• Continuing to engage in repeated sexual behaviors despite receiving little or no satisfaction from them

Compulsive sexual behavior can occur regardless of an individual's gender or sexual orientation, though it may be more common in men. The risk of compulsive sexual behavior may also be higher for people who have alcohol or drug use disorders, other mental health disorders, or childhood traumas, including sexual abuse.

While the causes of compulsive sexual behavior remain unknown, theories of possible causes include:

• Imbalance of brain chemicals affecting mood: certain chemicals in the brain, such as serotonin, dopamine, and norepinephrine, help control mood. When these chemicals are out of balance, sexual desire and behavior could be affected.
• Altered brain pathways: over time, compulsive sexual behavior might cause changes in the brain's pathways, especially in areas of the brain related to reinforcement. Eventually, more intense sexual content and stimulation are usually needed to obtain satisfaction or relief.
• Conditions that affect the brain: some health conditions, such as dementia, epilepsy, or bipolar disorder, may cause damage to parts of the brain that affect sexual behavior. Also, certain medications used to treat Parkinson's disease may cause compulsive sexual behavior.

There is ongoing debate among mental health experts over how to classify compulsive sexual behavior. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, serves as the predominant guide for diagnosing mental health conditions in the United States and does not include compulsive sexual behavior as a diagnosis. However, the condition may sometimes be diagnosed as part of another mental health condition, such as an impulse control disorder or a behavioral addiction. In contrast, the World Health Organization recently identified compulsive sexual behavior disorder as a diagnosis, which it includes among impulse control disorders.

Determining if sexual behaviors have become a problem is not always straightforward, and more research is required to establish standard guidelines for diagnosis. Nevertheless, whether hypersexual behavior is a compulsion or an addiction, there are individuals engaging in these behaviors who would like to receive help with managing their behavior. There are mental health professionals who specialize in treating addictions, including and compulsive sexual behaviors. Compulsive sexual behavior may be treated with:

• Psychotherapy: essentially, a mental health professional will help individuals identify and manage factors that might trigger compulsive sexual behaviors. Psychotherapy may be provided in individual sessions, as well as sessions with families or couples. These sessions may take place in person or online.
• Medications: while there is currently no medication specifically approved to treat compulsive sexual behavior, some medications used to treat other conditions may be prescribed, such as antidepressants, anti-anxiety medications, or mood stabilizers. These medications act on brain chemicals linked to urges and behaviors. They can lessen sexual urges and brain-chemical rewards that certain behaviors might provide. The medications that are most appropriate for an individual depends on that individual's circumstances, including any other mental health conditions.
• Support groups: these groups can help individuals learn about compulsive sexual behavior, receive support and understanding, identify treatment options and coping techniques, and prevent relapse. Support groups are often modeled after the 12-step program of Alcoholics Anonymous. Mental health professionals may be able to recommend particular groups that meet locally or online.

The principal goal of treatment for compulsive sexual behavior is to help individuals manage urges and reduce problematic behaviors while still enjoying healthy relationships.